Comprehensive Case Management Case Study

One of the hardest-working roles in the field of substance-use disorder treatment is that of the case manager (CM). In fact, the scope of case management is so broad that it is difficult to sum it up in a single sentence (Grand Canyon University (GCU) PCN-255 Lecture 1: Foundations of Case Management, 2015). Here is a brief discussion of what is required and typically expected of a CM practicing in this author’s home state of Oklahoma.

In this paper I will describe the criteria and strategies for termination of case management. I will also discuss how independent care will help in continued client growth. The process focuses on discontinuing case management when the client transitions to the highest level of function, the best possible outcome has been attained, or the needs/desires of the client change.

Case management is a process that ensures that you are provided with whatever services you may need in a coordinated, effective, and efficient manner,FIntagliata, 1981 as cited in Frankel & Gelman (2012).Treatment is structured to ensure smooth transitions to the next level of care, avoid gaps in service, and respond rapidly to the threat of relapse. Assessment, planning, linkage, monitoring, and advocacy are the functions that comprise case management.

Under the Balanced Budget Act (BBA), the Health Care Financing Administration (HCFA) put into effect a nationwide Prospective Payment System (PPS) within Skilled Nursing Facilities to reimburse inpatient service costs for beneficiaries covered under Medicare Part A as of July 1,1998 (Skilled Nursing facility PPS, 2013). Generally, Medicare Part A covers beneficiaries within the following inpatient settings: SNFs, hospitals, nursing homes, hospice, and home health services (What Part A Covers, n.d.). Medicare Part A uses a Prospective Payment System at a per diem rate. In other words, Medicare Part A pays SNFs pre-determined daily rates for patient care, meaning they are dictating the daily allowance of expenses used for services (Skilled Nursing

Our position in the market will be a full-service medical reimbursement business with individual pricing. As stated previously, our goal is one-stop shopping for medical practices when it comes to administrative functions. Reliance Medical Management, LLC Electronic Claims Service 's policy is to customize our charges based on the work we do, and the needs of each office. We find that each practice is unique and, therefore, we do not quote a "standard charge" for services.

Nurses use the heritage assessment tool to evaluate an individual in order to identify his or her personal needs based on his or her cultural background. To complete this assignment, I conducted a heritage assessment of three different families that are from three different cultures. For all the participants who participated, each participant recorded unique results from the rest of the participant. The results are closely relevant to cultural identification of each participant. The three participants were a 45 years old Haitian female, a 38 years old white female, and a 55 years old Indian female. The healthcare system is governed by the main goal of providing utmost care to the patient (Debiasi, 2017). To care for a family, the

RRMC’s external stakeholders consist of the community, patients, MedKey System members, CMS, HMOs and any other private insurances” (Richards & Slovensky, 2004). “One of the major constant struggles RRMC’s hospital administrators were facing was the low Medicare reimbursement rates and trying to operate the facility on such low reimbursements for their services which definitely became a significant external threat to the organization”(Richards & Slovensky, 2004). Eighty percent of patients at RRMC were Medicare or Blue Cross and the administration experienced much difficulty when it came to negotiating prices with Blue Cross due to monopoly”(Richards & Slovensky, 2004). In this market, buyers have high bargaining power because reimbursements

We begin each new relationship by evaluating call volumes for our clients, and assigning billing staff based on our formula for optimum service levels. Call volume and staff allocation are re-evaluated quarterly, and updated as necessary. This has proven not only successful in DM Medical servicing our clients with consistent quality, expeditious claim filing and appeals, but also ensures that our client’s accounts have the dedicated staff that their services warrants, and deserves.

Health information technology involves the design, development, creation, use, and maintenance of healthcare information systems. Information systems have become increasingly critical to clinical care and hospital operations, evolving technology is what supports the past, present, and future healthcare systems. This technology can assist healthcare organizations in improving medical care, lower costs, increase efficiency, reduce errors, improve patient satisfaction, and optimize reimbursement. Although the advanced of technology has been great there are still some major barriers in health information technology. It is important for healthcare organizations to overcome these barriers as well as meet the new standards of competition, innovations,

In Peter Segall’s HealthcareSource blog post, the writer pens his thoughts on management strategies in contemporary medical settings. [1] He reports that the field evolves continuously as researchers find new and better methods to heal patients. Abdulaziz Al-Sawai’s

Seton Insurance Services Strategy (attachment IV) was presented by Jeff Cook, Meredith Duncan, Wendy Smith, Dr. Stephen Benakich, Dewayne Wayne, and Tom Shock.

Competitive pricing pressure from a flooded market has forced significant consolidation and has shifted the landscape of the PC market and computer hardware industry. Some group of multinationals companies leads and have managed to maintained double-digit worldwide market share for several years. Specially in the Personal Computer industry, the two computers named as Dell and Hewlett-Packard- dominate the landscape. They have significantly more market share than their closest competitors (Microsoft, IBM, Sony, Fujitsu, Apple) on a global scale (34% of all PC shipments) and they account nearly half of domestic sales. A lot of these new shipments have reflected the demand for "volume servers" and enterprise servers, often a lower-end

Over the past decades, many high-level health care managers and planners in each country try to find the effective factors to the quality of treatment and their impact and selected the motto of " improving quality health care by improving the quality of information" from the their main goals. The health institutions should consistently apply Quality control (QC) to assess the quality of health care continuously. The patient's medical record is the first and most important source of collected information, because each record contains enough data to identify the full special patient, registered health issues and record any treatments [1]. All health care plans are performed based on illness data [2]. This subject is possible only using the exact classification of diseases and related law performance. The use of patient information will only be possible when they are properly organized and categorized. This is performed by coding of the diagnosis and treatment [3]. Coding is a related factor to the quality that is possible by coding medical records and

Principles of management are generally termed as the act of planning, organising and controlling the operations of the basic element of people, materials, machines, methods, money and markets, providing direction and coordination, and giving leadership to human efforts, so as to achieve the sought objectives.